Are 3-D mammograms any better than the standard 2-D images at detecting advanced breast cancer?
A clinical trial is recruiting thousands of volunteers-including many black women, who face disparities in breast cancer death rates-to try to find out.
People who signed up for the study to help answer the question include Carole Stovall, a psychologist in Washington, D.C.
The underrepresentation of women and minorities in research is a long-simmering problem that affects health issues such as Alzheimer’s disease, stroke and COVID-19. Trials without diversity lead to gaps in understanding how new treatments work for all people.
“Until we get more Black women into clinical trials, we can’t change the science. And we need better science for black bodies,” said Ricki Fairley, a breast cancer survivor and advocate working on this issue.
Black women are 40 percent more likely to die from breast cancer than white women and tend to be diagnosed at a younger age. But it’s not clear whether 3D mammography is better for them, said Dr. Worta McCaskill-Stevens of the National Cancer Institute.
McCaskill-Stevens, who is black, leads the NCI’s efforts to increase access to cancer research in minority and rural communities. She herself participated in the study.
New 3D technology is ten years old, but it’s never proven to be better than 2D at detecting advanced cancer. The screening technique combines several images of the breast, taken from different angles, to create an image that looks like 3D. The breast is compressed and low doses of radiation are used in both 3D and 2D mammograms.
Previous studies suggest that 3D finds more cancers than 2D, but finding more cancers doesn’t necessarily mean saving more lives. Some cancers missed by standard screening may not progress or require treatment. Previous studies did not randomly assign patients to screening, which is the gold standard for research.
The idea that “if it’s new and shiny, it’s better” is not necessarily true, McCaskill-Stevens said. “Until we have the evidence to support that, we need well-designed randomized trials.”
With a goal of 128,000 women, the study has enrolled nearly 93,000 women so far. The NCI-funded trial is now underway in Canada, South Korea, Peru, Argentina, Italy and 32 U.S. states. A site in Thailand will begin enrolling patients soon.